Real-world evaluation of novel eye drop bottle sensors: Cloud-based AI support for eye drop adherence.

Purpose: To understand real-world eye drop adherence among glaucoma patients and evaluate the performance of our proposed cloud-based support for eye drop adherence (CASEA). Design: Prospective, observational case series. Methods: Setting: The Department of Ophthalmology at Tsukazaki Hospital. Patient or study population: Glaucoma patients treated at the hospital from May 2021 to September 2022, with 61 patients initially enrolled. Intervention or observation procedures: Pharmacists guided eye drop administration before the study. Changes in bottle orientation were detected using an accelerometer attached to the container, and acceleration waveforms and date/time data were recorded. Patients visited the clinic during the 4th and 8th weeks to report their eye drop administration, and the data were uploaded to the cloud. Main outcome measures: Two AI models (B-LSTM) were created to analyze the eye drop bottle movement time-series data for patients treating one or both eyes. The models were evaluated by comparing the true administration status with the AI model judgment. Results: Four of the 61 study subjects dropped out. The remaining 57 patients achieved recall, precision, and accuracy values of 98.6 %, 98.6 %, and 95.9 %, respectively, for the two-eyes model and 95.8 %, 98.8 %, and 95.6 % for the one-eye model. Three low-accuracy participants (77.1 %, 71.0 %, and 81.0 %) improved to 100 %, 99.1 %, and 100 %, respectively, after undergoing an additional 8-week performance validation using an aid-type container designed to ensure that the bottle was fully inverted during instillation. Conclusions: CASEA precisely monitored daily eye drop adherence and enhanced treatment efficacy by identifying patients with difficulty self-medicating. This system has the potential to improve glaucoma patient outcomes by supporting adherence.

Comparison of visual performance between bifocal and extended-depth-of-focus intraocular lenses.

We compared the visual performance of a bifocal intraocular lens (IOL) (ZMB00) and an extended-depth-of-focus (EDOF) IOL (ZXR00V) by evaluating postoperative parameters at 10 weeks after the last surgery in cataract patients who underwent bilateral ZMB00 or ZXR00V implantation between 2011 and 2020. The right and left lenses were implanted within 3 months of each other. The study enrolled 1536 eyes of 768 patients; the ZMB00 group comprised 1326 eyes of 663 patients (age: 67.0 ± 7.8 years; female/male, 518/145), and the ZXR00V group comprised 210 eyes of 105 patients (age: 67.8 ± 6.9 years; female/male, 39/66). A linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations and pupil diameter, ensured statistical validity. Uncorrected near visual acuity, corrected near visual acuity, and near spectacle independence were significantly better in the ZMB00 group (p<0.00068, Wald test) than in the ZXR00V group. Contrast sensitivity (visual angle of the test target: 4.0°/2.5°/1.6°/1.0°/0.7°) and contrast sensitivity with glare (4.0°/2.5°/1.6°/1.0°/0.7°) were significantly better in the ZXR00V group (p<0.00068, Wald test) than in the ZMB00 group. Uncorrected intermediate visual acuity, contrast sensitivity with glare (6.3°), and 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) scores for General Vision were slightly but significantly better in the ZXR00V group than in the ZMB00 group (p<0.05, Wald test). At high-performance levels, the two IOL groups had different characteristics regarding various visual performance parameters.

Real-World Analysis of the Aging Effects on Visual Field Reliability Indices in Central 10-2 Tests.

We investigated the influence of aging on the reliability indices of visual field (VF) testing using a large dataset of central 10-2 program tests, including 6674 VF tests, which consisted of 1782 eyes of 1094 Japanese subjects (the mean age ± standard deviation was 66.6 ± 14.1 years). All of the combinations for each parameter, except for the pairs between age and fixation losses (FLs) or false positives (FPs) and between pattern standard deviation (PSD) and FPs, had significant correlations (p < 0.0001). Among the reliability indices, the false negatives (FNs) had the strongest correlation against age (the correlation coefficient was ρ = 0.21). Each reliability index changes differently with aging. The FLs were the highest in the first 10 s and remained constant after 20 s. The FNs remained constant for 60 s and rose steeply after 70 s. The FPs reached their highest value in 10 s and remained constant after 40 s. In mixed-effect regression analyses in 40-year-old or older subjects, older age was significantly associated with higher FNs (p < 0.0001) but not with FLs (p = 0.9014) and FPs (p = 0.9267). Compared to central 30-2 VF testing, central 10-2 VF tests were associated with smaller FLs (p < 0.0001) and FPs (p < 0.0001). In central 10-2 testing, age-related deterioration was seen in FNs but not in FLs and FPs. Choosing the 10-2 program over the 30-2 program can be effective in reducing the FL, especially in older cases with severe VF loss. This study highlighted the relationships between age and each reliability index in central 10-2 VF testing.

Real-World Analysis of the Aging Effects on Visual Field Reliability Indices in Humans.

Relationships between age and visual field (VF) reliability indices were investigated using a large real-world dataset (42,421 VF data points from 11,525 eyes of 5930 subjects). All VFs tested and stored at Shimane University Hospital between 1988 and 2019 were exported. Correlations between age, mean deviation (MD), pattern standard deviation (PSD), and reliability indices including fixation losses (FLs), false negatives (FNs), and false positives (FPs) were analyzed. The mean ± standard deviation age was 65.0 ± 15.1 years; MD--6.9 ± 8.1 decibels (dB); PSD-6.3 ± 4.6 dB; FL-8.6 ± 11.7%; FN-5.3 ± 8.3%; and FP-2.6 ± 5.0%. Univariate analyses showed strong associations between age and FNs (correlation coefficient, ρ = 0.20, p < 0.0001) and MD (ρ = -0.21, p < 0.0001). All FLs, FNs, and FPs were lowest during the third decade (20-29 years) of life. FLs were elevated consistently after that decade, and FNs were elevated sharply after the seventh decade. FPs were relatively stable after the fourth decade (30-39 years). Mixed-effect regression analyses in subjects 40 years and older showed that older age was associated with worse FLs (p < 0.0001) and FNs (p < 0.0001) but not FPs (p = 0.4126). Aging affects FLs and FNs with different modes but had minimal effects on FPs. Decreased VF sensitivity, deteriorated macular function, and technical difficulties with testing may be mechanisms of age-related changes in FLs and FNs.

Proposal of a simple grading system integrating cosmetic and tonometric aspects of prostaglandin-associated periorbitopathy.

ABSTRACT: The distribution of prostaglandin-associated periorbitopathy (PAP) graded using the Shimane University PAP Grading System (SU-PAP) among glaucoma/ocular hypertension subjects using a topical FP or EP2 receptor agonist was reported. A 460 consecutive 460 Japanese subjects (211 men, 249 women; mean age ±â€Šstandard deviation, 69.9 ±â€Š14.5 years) who had used either a FP agonist (0.005% latanoprost, 0.0015% tafluprost, 0.004% travoprost, 0.03% bimatoprost, or fixed combinations of these) or EP2-agonist (0.002% omidenepag isopropyl) for more than 3 months in at least 1 eye were retrospectively enrolled. Age, sex, prostaglandin, intraocular pressure (IOP) measured by Goldmann applanation tonometry (IOPGAT) and iCare rebound tonometry (IOPRBT), difference between IOPGAT and IOPRBT (IOPGAT-RBT), PAP grade, and PAP grading items were compared among groups stratified by PAP grade or prostaglandins. Of the study patients, 114 (25%) had grade 0 (no PAP), 174 (38%) grade 1 (superficial cosmetic PAP), 141 (31%) grade 2 (deep cosmetic PAP), and 31 (7%) grade 3 (tonometric PAP). The IOPGAT was significantly higher in grade 3 (17.5 ±â€Š5.4 mm Hg) than grades 0 (15.0 ±â€Š5.1 mm Hg, P = .032) and 1 (14.5 ±â€Š4.2 mm Hg, P = .008), and the IOPGAT-RBT was significantly higher in grade 3 (5.8 ±â€Š3.2 mm Hg) than the other 3 grades (1.3-1.9 mm Hg, P < .001 for all comparisons); the IOPRBT was equivalent among the 4 grades. The PAP grade was significantly higher associated with travoprost (2.0 ±â€Š0.8) and bimatoprost (2.0 ±â€Š0.7) than latanoprost (1.0 ±â€Š0.8, P < .001 for both comparisons) and tafluprost (1.0 ±â€Š0.7, P < .001 for both comparisons), but significantly lower associated with omidenepag (0.0 ±â€Š0.0, P < .001 for all comparisons) than the other 4 prostaglandins. Multivariate analyses showed older age (standard ß = 0.11), travoprost (0.53, referenced by latanoprost) and bimatoprost (0.65) were associated with higher PAP grades, while tafluprost (-0.18) and omidenepag (-0.73) were associated with lower PAP grades. The PAP graded using SU-PAP reflects the degree of overestimation of the IOPGAT and different severities of PAP among the different prostaglandins. SU-PAP, the grade system constructed based on the underlining mechanisms of PAP, is a simple grading system for PAP that is feasible for use in a real-world clinical situation.

Advanced Glycation End Product Accumulation in Subjects with Open-Angle Glaucoma with and without Exfoliation.

Advanced glycation end products (AGEs), which are the products of a non-enzymatic reaction between reducing sugars and other macromolecules, are critical in aging, as well as metabolic and degenerative diseases. To assess the involvement of AGEs in glaucoma, skin autofluorescence (sAF) level, which is a measurement of AGEs' accumulation, was compared among Japanese patients with glaucoma (316 with primary open-angle glaucoma (PG) and 127 exfoliation syndrome and glaucoma (EG)) and controls (133 nonglaucomatous controls) (mean age 71.6 ± 12.8 years, 254 men and 322 women). The sAF values were estimated from the middle fingertip using a 365 nm light-emitting diode for excitation and detection at 440 nm emission light. The estimated AGE values (arbitrary unit) were 0.56 ± 0.15, 0.56 ± 0.11, and 0.61 ± 0.11 in the control, PG, and EG groups, respectively (p < 0.0001, analysis of variance); and were significantly higher in the EG group than the control (p = 0.0007) and PG (p < 0.0001) groups. After adjustment for various demographic parameters by multivariate analyses, male sex (standard ß = 0.23), EG (0.19), and diabetes (0.09) were associated with higher AGE levels; PG (-0.18) and smoking (-0.19) were associated with lower AGE levels. Age, visual acuity, intraocular pressure, glaucoma medications, lens status, and systemic hypertension were not associated with AGEs. The high AGE level in EG suggested that specific oxidation and glycation mechanisms underlie the glaucoma pathogenesis associated with pseudoexfoliation syndrome.

Observation of Gonio Structures during Microhook Ab Interno Trabeculotomy Using a Novel Digital Microscope with Integrated Intraoperative Optical Coherence Tomography.

PURPOSE: Observation of ocular structures using microscope-integrated intraoperative optical coherence tomography (iOCT) has been adopted. Using the novel digital ophthalmic microscope, ARTEVO 800 with iOCT, we tested the feasibility of trabecular meshwork (TM) imaging during microhook ab interno trabeculotomy, a minimally invasive glaucoma surgery. METHODS: The nasal and temporal sides of the TM/inner wall of Schlemm's canal were incised more than 3 clock hours in 14 glaucomatous eyes of 10 patients. To observe the trabeculotomy site, iOCT was performed with the real-time five-line scan mode under observation using a Swan-Jacob gonioprism lens. The success of the imaging and visibility of the trabeculotomy cleft and its incisional patterns (i.e., anterior, middle, or posterior pattern) were determined by reviewing the iOCT video files. RESULTS: OCT images of the region of interest were acquired successfully in 100% of the 28 nasal or temporal sides in 14 eyes, although the trabeculotomy cleft was not visualized in four (14%) sides due to blockage of the OCT signal by a blood clot. Based on the predominant locations of the TM flaps in 24 of the acquired images, the trabeculotomy clefts were classified as anterior incisional patterns in 13 (54%), middle incisional patterns in nine (38%), and posterior incisional patterns in two (8%). CONCLUSION: Intraoperative imaging of the gonio structures including the trabeculotomy cleft was feasible using the ARTEVO 800 with iOCT in combination with a gonioprism.